Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I commend Deputy O'Reilly and her Sinn Féin colleagues on the introduction of this motion. This is the second time in a very short period of time that we have discussed this issue, which is one of the most pressing issues in the health service. It typifies everything that is wrong with the way health services are provided in this country. I refer again to the principles that underlie the Sláintecare plan, which is about providing services at the lowest level of complexity in the community as close to home as possible. The best place for older people and people who are infirm or disabled in any way to receive services is in their own homes. We know that if we provide the kinds of supports that are necessary for such people to remain in their homes, or to return to live in their homes, we will achieve the best health outcomes. Interestingly enough, it also gives by far the best value for money. Rather than recognising that principle, and its importance for older people in particular, the Minister and the Government are continuing to do things that work against this kind of success.

I will give some examples. In the past week, it has emerged that there are 585 people who are regarded as delayed discharges in our acute hospitals. The majority of them are in the big teaching and voluntary hospitals in the Dublin area. These people are misplaced. They should not be where they are. They have completed the acute phase of their treatment and are ready to move to a nursing home or another stepdown facility, or to go home if the services are available. Unfortunately, they are not available because of the ridiculous and scandalous way our health service operates.

When the chief executive of the mid-west hospital group appeared before the Committee on the Future of Healthcare some years ago, she told us there were approximately 40 delayed discharges in University Hospital Limerick. She said she would give anything to be able to set aside part of her budget to access home care services for the 40 or 44 people in question. She said that if they could move out, it would free up beds in the hospital, thereby allowing the hospital to deal with acute patients and make progress through waiting lists, which is what it is supposed to be doing. Rather than doing that, we have siloed organisation within the health service and we have siloed budgets. This means it is not possible to spend money in the places where it makes most sense to spend it. Health services, like so many other things for which this Government is responsible, are being provided in the most expensive and least effective way possible. The Government has known for years that this makes no sense. Why is it not addressing this issue?

If 585 beds in acute hospitals are being taken up by people who no longer need acute care, those patients are essentially staying in very expensive hospital beds on a bed and breakfast basis. They do not need consultants. They do not need nurses to any great extent. They are staying in beds while they wait for somewhere more appropriate to become available. Nearly 600 beds are not being used for what they should be used for, while the waiting lists continue to grow. There is a massive logjam in elective surgery in our public hospitals. We talk about providing more hospital beds and building new hospitals, etc. The very first thing we should do is ensure there is throughput within the hospital system. The 585 beds I have mentioned should be freed up to enable more people to come in, have their various operations and procedures and move out again. This kind of throughput is needed if we are to make progress through the hospital waiting lists. There are big tailbacks and waiting lists because those beds are not available. Their non-availability is one of the key reasons for the incredible waiting lists that exist at present. It is entirely indefensible that there are 550,000 waiting for outpatient appointments and approximately half as many again waiting for procedures. The solution is facing the Minister - it is right in front of him - but he not taking action.

Sometimes the hospitals do not complain about these arrangements because there is no work to be done to service the 585 beds. Where are the staff who are being paid to service those beds? Where are the consultants who are being paid to do operations and procedures on these 585 people? There is a perverse incentive here. It is certain that we are not getting value for money. We are preventing our highly paid hospital staff, particularly consultants, from doing the work they are being paid to do. Again, this makes no sense whatsoever.

However ridiculous it is that we do not free up those beds and make home care and home help services available, when one looks at what is happening on the community side, one can see that 6,000 people are waiting for home care services. Again, we are talking about very vulnerable people who are being forced to live in circumstances where there is little or no dignity and no respect for them. These people have already been assessed and found to be in need of home support services yet despite the fairly difficult and rigorous test they are put through and despite being told they are approved for home care, none is available. Essentially, they are being told that they must wait for other older people to die before hours are freed up or recycled, as the Minister of State referred to. This is outrageous. Apart from the fact that the Government is denying people the right to live in dignity in their own homes, those people are very much at risk and are much more likely to turn up in emergency departments at the weekends or in the middle of the night when they do not have support services. They are also far more likely to have falls and end up in acute hospitals for long periods. It makes no sense to do this.

When we spoke about this here recently, I asked the Minister of State, who had been twisting and turning so as not to portray it as a cut, how he was going to accommodate the additional travel time required to pay staff. He told me that the HSE would have to find that money elsewhere. I am still waiting for him to tell me where on earth it is going to find it. What he has done is a disgrace. This is a scandal. The Minister of State should get the finger out.

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